Are eGFR equations better than IDMS-traceable serum creatinine in classifying chronic kidney disease?

Pottel, Hans; Martens, Frank

doi:10.1080/00365510902811253

Cited by 13 publications

(8 citation statements)

References 28 publications

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“…It could be considered controversial in 2017 to assert that the estimating GFR (eGFR) by creatinine-based equations does not contain more information than the biomarker concentration itself, even if some authors have already claimed this [22,23] . It is true that the use of eGFR allows one better to take into account the variation of serum creatinine due to ethnicity, gender and age, these being the variables in the current eGFR equations [24][25][26][27][28] .…”

Section: Estimating Gfr Equations: a Solution That Generates Other Ismentioning

confidence: 99%

Serum Creatinine: Not So Simple!

Delanaye

Pottel²

2017

Nephron

Self Cite

268

171

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Measuring serum creatinine is cheap and commonly done in daily practice. However, interpretation of serum creatinine results is not always easy. In this review, we will briefly remind the physiological limitations of serum creatinine due notably to its tubular secretion and the influence of muscular mass or protein intake on its concentration. We mainly focus on the analytical limitations of serum creatinine, insisting on important concept such as reference intervals, standardization (and IDMS traceability), analytical interferences, analytical coefficient of variation (CV), biological CV and critical difference. Because the relationship between serum creatinine and glomerular filtration rate is hyperbolic, all these CVs will impact not only the precision of serum creatinine but still more the precision of different creatinine-based equations, especially in low or normal-low creatinine levels (or high or normal-high glomerular filtration rate range).

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Section: Estimating Gfr Equations: a Solution That Generates Other Ismentioning

confidence: 99%

Serum Creatinine: Not So Simple!

Delanaye

Pottel²

2017

Nephron

Self Cite

268

171

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“…Conversely, when considering the eGFR results in population studies, such a systematic error will be misleading in terms of CKD prevalence or CKD-related mortality and morbidity-associated risk [15,16]. This was specifically observed with the MDRD equation, which by underestimating the mean mGFR, overestimates the CKD stage 3 prevalence in the general population [7,[15][16][17][18].…”

Section: A S S E S S I N G T H E P E R Fo R M a N C E O F E Q U At I mentioning

confidence: 99%

Con: Should we abandon the use of the MDRD equation in favour of the CKD-EPI equation?

Delanaye¹,

Pottel²,

Botev³

2013

Nephrology Dialysis Transplantation

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“…While the reference range for eGFR should be narrower than that for serum creatinine, the eGFR essentially has no reference range because only quantitative results ≤60 ml/min/1.73 m 2 are reported, which prevents its use for detecting early changes in renal function or for evaluating persons with normal renal function. Pottel and Martens [15] present a provocative report claiming that the MDRD eGFR adds little to a simple creatinine compared to appropriate reference intervals based on age for males and females. Furthermore, they show that the stages of kidney disease can be classified by the serum creatinine values as well as by the GFR.…”

Section: Introductionmentioning

confidence: 99%

“…Furthermore, they show that the stages of kidney disease can be classified by the serum creatinine values as well as by the GFR. Using their data for males and females aged 50–54 years [table 1a, [15]], the stages of CKD can be associated with appropriate ranges for serum creatinine (table 1). …”

Section: Introductionmentioning

confidence: 99%

“…On average, the serum creatinine for females is about 0.2 mg/dl lower than for males, giving reference ranges of 0.5–1.1 mg/dl for females and 0.7–1.3 mg/dl for males. In addition, serum creatinine declines gradually with age, approximately by 0.1–0.2 mg/dl every 5 years throughout adulthood [15]. Even though the eGFR uses ‘GFR’ in its name, it is actually proportional to a serum creatinine adjusted for age, gender, and race.…”

Section: Introductionmentioning

confidence: 99%

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Improving the Clinical Value of Estimating Glomerular Filtration Rate by Reporting All Values: A Contrarian Viewpoint

Toffaletti

2010

Nephron Clin Pract

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The serious limitations of the estimating glomerular filtration rate (eGFR) appear related not to a shortcoming of the equation, but to the futility of trying to force agreement between two inherently different parameters: a blood marker of kidney function with a very stable concentration (creatinine) and a renal filtration parameter that fluctuates continually (glomerular filtration rate, GFR). Although GFR is regarded as the ultimate determinant of kidney function, it may be less ideal as an early clinical marker to detect declining kidney function. Another shortcoming of GFR is that it has significant overlap between health and kidney disease states categorized according to stage I, II, etc. Serum creatinine has a real and measurable increase as kidney function declines, but this is often masked when creatinine is plotted on a scale of 1.0 mg/dl (88 µmol/l), which is well above the detection limit of modern creatinine methods of about 0.05 mg/dl. A new equation to estimate GFR, the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) creatinine equation, modestly improves accuracy from 80.6% of the Modification of Diet in Renal Disease eGFRs being within 30% of the measured GFR, to 84.1% of the CKD-EPI eGFRs being within 30% of the measured GFR. Creatinine methods have recently been standardized to an isotope dilution mass stectrometry reference method. While this will lessen the systematic bias between methods, it will have no effect on either the imprecision of a particular creatinine method or on the inherent random differences between serum creatinine (or eGFR) and actual GFR. Finally, the eGFR is not recommended for reporting until it is well below a reference range for those with no kidney disease. However, if the eGFR were properly regarded as an age-, gender-, and race-adjusted serum creatinine, it could be reported at all values and become a more clinically useful parameter.

show abstract

Are eGFR equations better than IDMS-traceable serum creatinine in classifying chronic kidney disease?

Cited by 13 publications

References 28 publications

Serum Creatinine: Not So Simple!

Serum Creatinine: Not So Simple!

Con: Should we abandon the use of the MDRD equation in favour of the CKD-EPI equation?

Improving the Clinical Value of Estimating Glomerular Filtration Rate by Reporting All Values: A Contrarian Viewpoint

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